Oral health status and treatment needs among primary school going children in Nagrota Bagwan block of Kangra, Himachal Pradesh.

BACKGROUND: Oral diseases such as gingival diseases and dental caries affect about 80% of the school students worldwide. The study was taken up with the aim to evaluate the oral health status and treatment need in the School going children of Nagrota Bagwan Block of Kangra District, Himachal Pradesh.
MATERIALS AND METHODS: A total number of 3069 school children in the age group of 5-12 years studying in 96 government primary schools of study area were surveyed to find out the Oral Hygiene Index simplified (OHI-S) scores, community periodontal index (CPI) scores, dental caries and treatment need using dentition status and treatment need index (WHO diagnostic criteria, 1997).
RESULTS: The mean OHI-S was 2.7 ± 2.81and 2.8 ± 2.99 in 5-8 and 9-12 years age group, respectively. The gingival bleeding was observed in 76.8% and 75.9%, calculus in 10.2% and 18.3% in 5-8 and 9-12 years age group, respectively. The overall caries prevalence of subjects was 58.4% with high caries prevalence in females as compared to males and in 9-12 years age group as compared to 5-8 years age group. The mean dmft/DMFT was 2.05 ± 4.13 and 2.56 ± 4.20 in 5-8 years and 9-12 years age group, respectively. Treatment need observed was 62.3% and 75.3% in 5-8 and 9-12 years age group, respectively.
CONCLUSION: The study demonstrated that school children in Nagrota Bagwan, Kangra district suffer from high prevalence of dental caries and have high treatment need as well as poor oral hygiene and gingival health status.

INTRODUCTION

Oral health is an integral part of the general health and well-being of an individual and is now recognized as equally important in relation to general health. Among common oral diseases, dental caries and periodontal diseases are the two foremost oral pathologies that remain widely prevalent and affect all populations throughout the life span.[1] Oral diseases continue to have high prevalence despite the decline in dental caries in developed countries. The observation of the various studies shows the increasing levels of dental caries in children and adolescents in developing countries, in contrast to developed countries.[23] The National Oral Health Survey and Fluoride mapping-2003[4] reported that 72.5% of 12-year-old children and 75.4% of 15-year-old children had dental caries. Knowledge of dental health and treatment needs of school children is important for developing appropriate preventive approaches, anticipating utilization patterns, and planning effectively for organization and financing of dental resources. Therefore, the following study was taken up with the aim to evaluate the oral health status and treatment need in the School going children of the field practice area in medical college in Kangra District of Himachal Pradesh State.

MATERIALS AND METHODS

This community-based observational cross-sectional study was conducted at Nagrota Bhagwan block of Kangra district, Himachal Pradesh, which is a field practice area of the Department of Community Medicine, Dr. R.P. Govt. Medical College, Kangra (HP). Nagrota Bhagwan block has a population of 1,10,039 which inhabits a total number of 213 rural villages and 7 urban wards. There were 96 Govt. primary schools in the block and a total number of 3096 school children in the age group of 5-12 years. All the school children in the age group of 5-12 years studying in 96 Govt. primary schools of the block were recruited for the study. It comprised approximately 12-13% of the total population of the block. The literacy rate in the age group of 5-12 years is more than 95% and majority of children study in govt. schools of the area. Hence, the study population was the true representative of the population. The study was conducted from May 2012 to July 2013.

Collection of data

Each school was visited a maximum number of 3 days in a week or less till all children were examined. If it required more than 3 days, then remaining children were covered in subsequent week. Indices were used for calibration and appropriate changes were made during the pretesting of the Performa.

Data was collected regarding:

The prevalence of dental caries (using dentition status and treatment need index as described by WHO-Oral health survey manual, 1997)

The prevalence of periodontal diseases using CPI (Community Periodontal Index)

Oral health status (Oral hygiene index-simplified).

Oral health examination of each subject was done by seating each one on a chair in the daylight with subject facing away from the direct sunlight using required instruments. The Performa was filled up by two field investigators. Each field investigator was handed over separate age groups of school children (one for 5-8 years and another for 9-12 years) in order to avoid interviewers and information bias.

Ethical issues

Ethical clearance was obtained from the concerned authorities of the institution. The study participants were given clear explanation about the objective of the study. Voluntary informed consent was obtained from the parents of school children and the school teachers before administering the questionnaire.

Statistical analysis

Data obtained was entered in an MS-Excel spreadsheet and analyzed using Epi info software. Categorical variables were compared using the Chi-square test. A level of P ≤ 0.05 was considered statistically significant and P ≤ 0.001 was noted as highly significant. The accuracy of data entry was checked by re-entering 10% of the data and the consistency of the data was compared.

RESULTS

A total number of 3069 school going children in the age group of 5-8 years and 9-12 years were enrolled in the study. Among the age group of 5-8 years, 54.7% were males and 45.3% were females. In the age group of 9-12 years, 45.3% were males and 50.3% were females [Table 1].

Table 1

Distribution of sample

Oral hygiene status assessment of the study population using Green and Vermillion index-simplified, (OHI-S)

Among 5-8 years of age group, 9.4% had good oral hygiene, 63.6% had fairly good oral hygiene and 26.8% had poor oral hygiene. In the above assessment, it was noted that males had significantly fair oral hygiene than females (P = 0.006). However, there was no statistically significant difference between males and females in respect of good (P = 1.4) and poor oral hygiene (P = 0.78) [Table 2a].

Table 2a

Gingival assessment using oral hygiene index-simplified

Among 9-12 years of age group, 7.3% had good oral hygiene, 51.5% had fairly good oral hygiene and 41.1% were had poor oral hygiene. There was no statistically significant difference in the oral hygiene of males and females. After comparing both the age groups, it was noted that 5-8 years of age group exhibited significantly good oral hygiene as compared to the 9-12 years age group (P = 0.07). The OHI-S score values showed an increase with the age and the females were more affected as compared to the males.

Mean OHI-S was 2.7 ± 2.81 and 2.8 ± 2.99 in 5-8 and 9-12 years age group, respectively [Table 2b]. There was no significant difference between mean OHI-S values in males and females. However, the mean OHI-S values showed an increase with the age.

Table 2b

Mean OHI-S

Gingival and periodontal assessment of the study population using community periodontal index

It was noted that among the age group of 5-8 years, the females had significantly higher gingival bleeding as compared to males [Table 3].

Table 3

Gingival and periodontal assessment using CPI

In 9-12 years of age group, the males had significantly higher gingival bleeding as compared to females (P = 0.03). The females had high calculus deposits as compared to males, however, the difference was not significant (P = 0.07). Among both the groups, 5-8 years of age group exhibited significantly more gingival bleeding as compared to 9-12 years of age group (P = 0.02).

Dental caries assessment in study population

The prevalence of dental caries varied among the study subgroups. Overall, the prevalence of caries subjects in the study population was 58.4%. High caries prevalence was seen in the age group of 9-12 years (61.2%) as compared to the age groups of 5-8 years (56.8%). Higher caries subjects were found among the females (60.9%) as compared to males (56.2%). However, the difference was not significant. Females had significantly high prevalence of dental caries in the age group of 5-8 years as compared to males in the same age group [Table 4a].

Table 4a

Prevalence of dental caries

Mean dmft/DMFT scores were 2.05 ± 4.13 and 2.56 ± 4.20 in 5-8 and 9-12 years age groups, respectively [Table 4b].

Table 4b

The dmft/DMFT and its components scores (mean±SD)

The decayed component accounted for more than 85% of these values. There were significant differences in means of decayed component (D + d) among both the age groups, with the highest mean (D and d) scored by the 9-12 years age group (1.37 and 1.17, respectively).

The females had significantly higher mean dmft/DMFT as compared to males in the 9-12 years age group [Table 4c].

Table 4c

The dmft/DMFT and its components scores (mean±SD) by age and gender distribution

Treatment needs of the study population

In 5-8 years of age group, out of 1170 (62.3%) requiring treatment, the need for pit and fissure sealants was highest (49.9%), where need for restorative care came next [(38.2%, one surface restoration), (27.6%, two surface restorations)] followed by the need for pulp treatment (17.5%) and extraction (11.1%) [Table 5].

Table 5

Treatment need of children

In 9-12 years of age group: Out of 898 (75.3%) requiring treatment, the need for pit and fissure sealants was highest (41.0%). The need for restorative care came next (31.2%, one surface restoration), (39.9%, two surface restorations) followed by the need for pulp treatment (13.5%) and extraction (8.9%).

There was no significant difference in the treatment need in both the age groups. However, the treatment need was significantly higher among females in 9-12 years of age group as compared to males in the same age group (P = 0.0005).

The treatment need in study population showed increase with age.

DISCUSSION

This study assessed the prevalence of dental caries and periodontal diseases and evaluated the treatment need of children in primary schools of a rural area.

In the present study, the percentage of children with good oral hygiene was very low (9.4% and 7.3% in 5-8 and 9-12 years age group, respectively) and percentage with fairly good hygiene was 63.6% and 51.5% in 5-8 and 9-12 years of age group, respectively. There was a high percentage of school children with good and fairly good oral hygiene in the age group of 5-8 years as compared to the age group of 9-12 years. OHI-S score values also showed an increase with the age. This was believed to be a result of newly erupted teeth and because most of the teeth lie in the anterior segment of the arches where the teeth could be cleaned as the child bites on a cloth and other objects and not necessarily as a direct maintenance of the child's oral hygiene. The mean OHI-S was 2.7 ± 2.81 and 2.8 ± 2.97 in 5-8 and 9-12 years age group, respectively. There was no significant difference between the mean OHI-S values in males and females. However, the mean OHI-S showed an increase with the age which is similar to the findings of the other studies.[5]

The gingival bleeding was observed in 76.8% and 75.9%, calculus in 10.2% and 18.3% in 5-8 and 9-12 years of age group, respectively. This is in contrast to results of other studies which had reported that 27% (n = 14) and 5% (n = 13) were with bleeding gums[67] and 79.5% (n = 260) children were having dental calculus.[8] The variation could be due to difference in various factors like diet, life style etc., The females had significantly higher gingival bleeding in 5-8 years of age group as compared to males. This may be due to significantly fair oral hygiene in males as compared to females in this age group.

The overall caries prevalence of subjects was 58.4% with high caries prevalence among females as compared to males, and in 9-12 years age group as compared to 5-8 years age group.

The mean dmft/DMFT was 2.05 ± 4.13 and 2.56 ± 4.20 in 5-8 years and in 9-12 years age group, respectively. The values of this study were higher as compared to values reported in studies by Shailee et al.,[9] Grewal et al.[10] and Bajoma et al.[11] However, the values were almost similar to DMFT of 2.4 reported by National Oral Health Survey.[4] The major component was decayed components which was significantly higher in 9-12 years age groups compared to 5-8 years age group. Females had significantly higher mean DMFT value than males which is in line with the findings of other studies.[12131415161718] This finding may be due to the fact that teeth erupt earlier in females than males which means females teeth would have been exposed to oral environment for a longer period than the males of the same age.

The reason for the higher prevalence of dental caries in 9-12 years as compared to 5-8 years may be that caries being a continuous and cumulative process had obviously increased over a span of years; moreover, the number of teeth is more as the age increases.

On assessment of treatment needs, the treatment need observed at baseline examination was higher in the present study i.e. (62.3% and 75.3% in 5-8 and 9-12 years age group, respectively) as compared to other studies.[19] When categorized according to treatment needs, it was found that the greatest need was for fissure sealants, one surface restoration followed by two-surface restorations, pulp restoration, and extractions. This is similar to the findings of other studies[1920212223] except the need for fissure sealants which was higher in present study compared to other studies.[24] It could be due to the difference in the lifestyles, dietary habits and socioeconomic factors in children.

The findings of the study demonstrated that school children in Nagrota Bagwan Block of Kangra district suffer from high prevalence of dental caries and treatment needs as well as poor oral hygiene and gingival health status. This study gives an overview of the existing oral health status and the treatment needs in school children and can help in implementing programs to achieve optimal health for children. Information provided by the present study can be used as preliminary data and further large-scale epidemiological studies can be undertaken at a district level to access and confirm various dental diseases and associated risk factors in the region. School dental health programs should be conducted at regular intervals, because children in this rural area do not have access to qualified dental care.

The limitations of the study are that predicting variables such as oral health knowledge and attitudes, patterns of sugar consumptions, oral hygiene behavior, social habits and fluoride intake have not been included in the study that influence the oral health of the individual.